Individual
JARED ALLEN PENDERGRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
500 PORTER AVE, AURORA, MO 65605-2365
(417) 678-7888
Mailing address
500 PORTER AVE, AURORA, MO 65605-2365
(417) 678-7888
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2020009814
MO
Other
Enumeration date
10/12/2020
Last updated
10/27/2020
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